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241 MDS Course File

Course Title: Physics of Diagnostic Radiology
Course Number and Code: 241 MDS
Credit hours: 4 hours (2 lectures + 2 clinics)
Level: 2nd year
Prerequisite: None

رقم المقرر ورمزة: 241 راس   
اسم المقرر: فيزياء اشعة الفم التشخيصية
عدد الساعات:  4  ( 2 ساعة محاضرة و 2 ساعات عيادات)  
المتطلب السابق: لايوجد

وصف المقرر

هذا المقرر يعطي الطالب معلومات اولية عن علم اشعة الفم . كذلك يتعلم الطالب كيف يفحص الفم من خلال دراسة الاشعة. ومن خلال هذة الماده يتعلم الطالب كيف يعمل اشعة الفم وماهي القواعد الفيزيائية للاشعة. وكيف نتعامل مع الاشعة  السينية.

 Course Description:
An introduction to dental radiology as a branch of dentistry for diagnostic, treatment planning and following-up purposes. Complete examination of the oral cavity needs both clinical and radiographic investigations, therefore this course of dental radiology offers the way of examining the hidden parts of teeth and their supporting structures. This course is considered as an introductory course that includes lectures, demonstrations and practical applications on the previously given lectures. It is consisted of a series of weekly lectures and practicals extending over two terms.

The use of x-rays is an essential part of clinical dentistry. As a result, radiographs are often referred to as the clinician main diagnostic aid. The range of knowledge of dental radiography and radiology required can be divided conveniently into four main sections:

1.Basic physics and equipment: the production of x-rays, their properties and interaction which results in the formation of the radiographic image.

2.Radiography: the techniques involved in producing the various radiographic images as well as the x-ray films and other radiographic requirements as well as film processing.

3.Radiation protection: the protection of patients and dental staff from the harmful effects of x-rays.

4.Radiology: the interpretation of the radiographic images.

This course is primarily concerned with the first three topics namely physics, radiography and protection. Only part of film interpretation for simple lesions as caries, periodontal and periapical diseases will be covered. However, the more comprehensive cases and differential diagnosis will be covered in the third year course.


Course Objectives

At the end of this course, the students will be able to:

1. Know how x-rays are produced, identify the component parts of the x-ray machine and its accessories and list and describe the possible interactions of x-rays with matter.

2.List and describe the different types of intra-oral and extra-oral x-ray films used in dentistry including their sizes, speeds as well as how to store them properly.

3.Identify the quality of x-ray image regarding the radiographic density, contrast, sharpness, magnification and distortion. Also, knows what is required to produce an ideal radiographic image.

4.List, discuss and practice the step-by-step procedures for both manual and automatic processing.

5.Make complete intra-oral radiographic survey [CMS] on patients, process, mount then, detect and retake the unsatisfactory radiographs.

6.Identify the radiographic anatomical landmarks as seen in radiographs, distinguish between normalities and normal variations. Also, to differentiate between those landmarks and some pathological lesions.

7.List and discuss the common causes of unsatisfactory radiographs, their causes and how to avoid them.

8.Discuss the harmful effects of radiation, both the short and long-term effects, whether they are somatic or genetic.

9.Protects his patients, the dental staff and people in the immediate environment from the harmful effects of radiation.

10. Detect, identify and describe the radiographic appearance of dental caries, periodontal and periapical pathosis. Also, to identify radiographically the existence of various dental anomalies and regressive changes which may affect teeth as well as various forms of trauma to the teeth.

11. Know the indications and techniques used for taking occlusal radiographs. And to discuss the purpose of localization techniques followed for identifying the exact locations of anatomical landmarks and foreign bodies.

12. Describe the principles, indications, advantages and disadvantages of panoramic radiography. Also, to practice the step-by-step taking a panoramic radiograph, chose the proper exposure parameters, patient preparation, and patient positioning. Also, the radiographic errors which may arise and how to avoid their incidence.

13. Discuss the types, indications, advantages, disadvantages and facilities offered by digital radiography as a recent modality and future of dental radiography.

14. Know the quality control tests that should be included in the quality assurance plan in order to keep a high quality radiographic procedures and hence high quality images. Also, to know the principles of infection control used in dental radiography.

15. Write a detailed report about all the abnormalities identified in a complete mouth survey (CMS).


16. Know the various radiographic procedures and techniques followed during endodontic treatment.

Specialties making use of the course
All clinical specialties including, restorative dentistry, Endodontics, Fixed and Removable Prosthodontics, Orthodontics, Periodontics, Pedodontics, Oral and Maxillofacial Surgery.


Course content
First Semester

• Introduction to dental radiology
• Radiation physics I
• Radiation physics II
• Dental x-ray film and requirements
• Dental x-ray image characteristics
• Processing of x-ray film
• Intra-oral radiographic techniques I
• Intra-oral radiographic techniques II
• Normal radiographic anatomy
• Common causes of unsatisfactory radiographs and their correction
• Radiation biology
• Protection from x-rays

Second Semester

• Interpretation of dental caries
• Interpretation of periapical pathosis
• Interpretation of periodontal disease I
• Interpretation of periodontal disease II
• Dental anomalies I
• Dental anomalies II
• Regressive changes of teeth
• Occlusal radiography and localization techniques
• Panoramic radiography I
• Panoramic radiography II
• Extra-oral radiography.
• Traumatic injuries to the teeth
• Digital radiography
• Quality assurance and infection control in dental radiography

Lecture Topics in details (content)

First Semester

Introduction
An introduction to dental radiology including the basic strategies of the division and component parts of the curriculum.

Radiation Physics I
The discovery of x-rays, Properties of x-rays, the x-ray tube and generation of x-rays, the x-ray machine , tube current and rectification, ideal requirements of a dental x-ray machine.

Radiation Physics II
Types of radiation produced, general radiation, characteristic radiation, interaction of radiation, no interaction, photoelectric effect, Compton scatter coherent scatter, radiation definitions, primary, secondary , scatter , stray, hard and soft radiation, useful beam, radiation exposure, inverse square law, half value layer, and factors affecting the x-ray image.

Dental X-ray Film and Dental Radiographic Equipment
Composition of x-ray film, latent image formation, types of x-ray films, intra-oral films, periapical,  bite-wing and  occlusal films. Intra-oral film packet, intra-oral film sizes and film speed. Extra-oral film packaging, sizes, types, and extra-oral film equipment , intensifying screens and cassettes. Duplicating film and x-ray film storage.
Dental x-ray image characteristics
Visual characteristics, including density and contrast. Geometric characteristics, including  sharpness, magnification and distortion.

Processing of X-ray Film
Purpose, steps, processing solutions, transformation of the latent image into a visible image, the dark room requirement  and contents. Manual  methods of film processing including, the visual method and fixed time - temperature technique. Automatic  processing of films.

Intra-oral Radiographic Techniques I
Indications of periapical radiography, Periapical radiography using the paralleling technique, film holders. Advantages and disadvantages of the technique.


Intra-oral Radiographic Techniques II
Periapical radiography using the bisecting technique, Advantages and disadvantages of the technique,  film holders. Bite-wing  radiography.
Normal radiographic anatomy
Radiolucent and radiopaque radiographic landmarks of the mandible and maxilla as seen in intra-oral films and larger  landmarks as seen in occlusal and extra-oral films.

Common Causes of Unsatisfactory Radiographs
Why should we avoid unsatisfactory radiographs?  I. Projection and handling errors including : shape distortion ( foreshortening, elongation, distortion ), overlapping, apical ends cut off, crowns of teeth not showing, the specific region not showing, cone cut, embossed pattern showing, black dot on the apical area, double image, blurred image, radiopaque shadows, artifacts or marks on the film (writing lines, black marks, black lines, black crescents). II. Exposure and processing errors including : Low density (faint) image, high density (dark)  image. high contrast, low contrast, fogging, black spots, black wide lines, white spots, white lines (streaks), black smudge marks, black streaks “tree-like”, partial blank image, blank image, reticulation, yellowish brown discoloration.

Radiation Biology
Mechanism of radiation injury (ionization, free radical formation). Theories of radiation injury (direct and indirect theories). Stochastic and non-stochastic radiation effects. Radiation injury, sequence, repair and accumulation. Determining factors for radiation injury ( total dose, dose rate, amount of tissue irradiated, cell sensitivity, age). Radiation effects (short-term and long term effects , somatic and genetic effects). Radiation effects on cells and tissues and radiation sensitivity of different tissues and organs.  The ALARA rule. Radiation measurements (units of measurement, exposure measurement, dose measurement dose equivalent measurement, measurement used in dental radiography . Radiation risks (sources of radiation exposure. Dental radiation and exposure risk, patient exposure and dose. The risk versus the benefit of dental radiographs.

Radiation Protection
I. Patient protection including: (A) safe equipment (filtration, collimation, timers, PID, film selection, film holders, kilovoltage, shielding, equipment maintenance), (B) proper technique (source to film distance, proper technique and processing) (C) professional judgment and patient selection criteria. II. Operator protection including: (A) from primary radiation (B) from scatter radiation (barriers, operator position and distance, personal monitoring). III. Protection of the immediate environment (shields, patient’s position, monitoring devices).

Second Semester

Interpretation of Dental Caries
Rationale for the use of intra-oral radiographs, examinations, frequency, Radiographic appearance of caries. Occlusal caries ( incipient, moderate, severe), radiographic pitfalls in the interpretation of occlusal caries. Proximal caries ( incipient, moderate, advanced, severe), pitfalls in the interpretation of proximal caries. Facial, buccal and lingual caries, root surface caries, pitfalls in the interpretation of root surface caries recurrent caries,  rampant caries,  radiation caries.

Interpretation of Periapical Pathosis
Anatomical pseudoperiapical radiolucencies, true periaical radiolucent lesions
Periapical granuloma, radicular cyst, periapical scar, chronic and acute dento-alveolar abscesses, surgical defect, periapical cementoosseous dysplasia (periapical cementoma).
Interpretation of periodontal disease (two lectures)
Contributions of radiographs, limitations of radiographs, technical considerations (types of films used, techniques and angles of projection), normal anatomy, alveolar bone loss (vertical, horizontal, severity). Classification of periodontal disease (periodontitis, early, moderate, advanced). Osseous defects, furcation involvements and limitation of radiographs in their examination, juvenile periodontitis, periodontal abscess, dental conditions associated with periodontal disease, occlusal trauma. The successful  periodontal therapy.

Dental Anomalies
Number of teeth (supernumerary teeth, missing teeth), size of teeth (macrodontia, microdontia), eruption of teeth (transposition, pre-deciduous and post –permanent dentitions), Altered morphology of teeth (fusion, germination, concrescence, dilaceration, dense in dent, dense invaginatus,  taurodontism, enamel pearl, Talon cusp, congenital syphilis). Alterations in tooth structure (amelogenesis imperfecta, dentinigenesis imperfecta, osteogenesis imperfecta, regional odontoplasia, Turner’s hypoplasia).

Regressive Changes of Teeth
Attrition, abrasion, erosion, tooth resorption (internal resorption, external resorption), secondary dentin, pulp stones, pulp sclerosis, hypercementosis.

Occlusal Radiography / Localization Techniques
Maxillary occlusal projections (topographic, anterior and lateral, cross sectional). Mandibular occlusal projections (topographic and cross sectional). N.B. each projection should include both the main indications and technique and positioning). The buccal object rule.

Panoramic Radiography I
Fundamentals of panoramic radiography (tomography, scangraphy, rotation centre,  focal trough). Equipment : Panoramic x-ray unit (panoramic tubehead, head positioner,  exposure controls). Films, Intensifying screens,  Cassette. Main indications of panoramic radiography. Advantages and disadvantages of panoramic radiography.

Panoramic Radiography II
Exposure of the panoramic film (Equipment preparation :  Patient preparation,
 Patient positioning. correct patient positioning). Common errors in panoramic radiography (patient preparation errors, patient positioning errors, other common errors).

Extra-oral Radiography
The general indications of  extra-oral radiography in . The lateral and  posteroanterior views and the indications of each.

Traumatic Injuries to the Teeth
Introduction, radiographic signs of dental fractures, concussion, luxation, avulsion, crown fractures,
root fractures, crown-root fractures, vertical root fractures, fractures of the alveolar process.

Digital Radiography
Introduction, analogue and digital images, basic requirements, direct and indirect DR. The Charged coupled device and image plate systems. Facilities offered by DR. Advantages and disadvantages of DR

Quality Assurance and Infection Control in Dental Radiography
Quality control tests, equipment and supplies : dental x-ray machines, dental x-ray film, screens and cassettes, viewing equipment, film processing, dark room lighting (discussed before), processing equipment, processing solutions. Infection control procedures in dental radiography.

Guidelines for Prescribing Dental Radiographs
Role of radiographs in disease detection and monitoring. Types of radiographic examination and the guidelines for ordering radiographs considering each patient category. Special considerations during ordering radiographs.

 Methods of teaching the curriculum

Didactic and clinical

Evaluation and Grades

There will be two continuous assessments during the semester, covering material from reading in the textbook, lectures and practical sessions. Students are encouraged to discuss the answers of questions in the exams in groups as an aid for understanding and learning the material in their radiology course.

  Test  Format  Grades
1st Cont. Ass. Written

10%

2nd Cont. Ass [Mid-Year] Written & Practical

20%

3rd Cont. Ass. Written

10%

Final Written & Practical

40%

Practical / Requirements

   20%

 Total

100%

Reference Textbooks

Reference available in school library and Student Bookstore 

Oral Radiology Principles and Interpretation
5th Edition - White and Pharoh (2004)

 

 

 

 

 

Dental Radiography, Principles and Techniques
2nd Edition  by Joen Haring and Laura Jansen

 

 

 

 

 

 

Lecture Outline

  First semester - Lecture Outeline

Week

Topic

Lecturer

1

Introduction

Ekram (DUC,MUC)

2

Radiation Physics I

Ekram (DUC,MUC)

3

Radiation Physics II

Ekram (DUC,MUC)

4

Dental X-ray Film and Requirements

Ekram (DUC,MUC)

5

Dental X-ray Image Characteristics

Ekram (DUC,MUC)

6

Processing of X-ray Film

Ekram (DUC,MUC)

7

Intraoral Radiographic Techniques I

 Sadhan (DUC), Faleh  (MUC)

8

1st Continuous Assessment

Staff

9

Intraoral Radiographic Techniques II

Sadhan (DUC), Faleh  (MUC)

10

Normal Radiographic Anatomy

Sadhan (DUC), Faleh  (MUC)

11

Common Cause of Unsatisfactory Radiographs and  their Correction

Sadhan (DUC), Faleh  (MUC)

12

Radiation Biology

Ekram (DUC,MUC)

13

Radiation Protection

Ekram (DUC,MUC)

14

Rivision

Ekram (DUC,MUC)

15

Mid-Year Examination

Staff


First Semester - Practical Outline

 

Week

Group

Exercise

 

1

A

B

C

Videotape discovery of x-rays 1 hour (following the lecture)

Orientation and divisional Tour 1 hour

 

2

A

B

C

X-ray tube, filter, collimator ,PID

X-ray machine, filter, collimator ,PID, control panel

X-ray machine, filter, collimator ,PID, control panel

 

3

A

B

C

Effect of x-rays on the film   PRE + Flourescence phenomena

Penetration of x-rays

 

4

A

B

C

Types of films, film packet and film cassette + Effect of film speed on film density

Effects of pressure and light on the film

                                                                                                  

 

5

A

B

C

Effect of kVp on contrast

Effect of FFD on film magnification & density + Effect of Exposure Time on density

 

6

A

B

C

The darkroom components & safe light (coin test) + Automatic processing.

Manual processing & Effect of Solutions

 

 

7

A

B

 C 

The paralleling technique (video tape) (1 hour)

Demo (on skull)

 

8

A

B

C

Film placement on colleges

 

9

CAT

 

10

A

B

C

 

Radiographic anatomy (PP Exercise (after Lecture, all groups)        

Film mounting A & B

 

11

 A

 B

 C

Radiographic pitfalls (PP Exercise)  (after lecture, all groups)

Film mounting C

 

 

12

A

B

C

Skull Exercise (Paralelling technique) & mounting of CMS

 

13

A

B

C

 

Skull Exercise (Paralelling technique) & mounting of CMS

14

A

B

C

Revisions , Retakes and evaluation

 

Second Semester - Lecture Outeline

TOPICS to be  COVERED

Lecturer

1

Orientation to the Course

Ekram (DUC,MUC)

2

Interpretation of dental caries

Sadhan (DUC), Faleh  (MUC)

3

Interpretation of periapical  pathosis

Sadhan (DUC), Faleh  (MUC)

4

Interpretation of periodontal disease

Ekram (DUC,MUC)

5

Digital Radiography

Ekram (DUC,MUC)

6

Developmental  anomalies of teeth

Ekram (DUC,MUC)

7

Acquired anomalies of teeth.

Sadhan (DUC), Faleh  (MUC)

8

Quality assurance and infection control in dental radiography

Sadhan (DUC), Faleh  (MUC)

9

Occlusal radiography/ Localization techniques

Sadhan (DUC), Faleh  (MUC)

10

Panoramic radiography I

Ekram (DUC,MUC)

11

Panoramic radiography II

Ekram (DUC,MUC)

12

Extra-Oral Radiography.

Ekram (DUC,MUC)

13

Traumatic injuries to the teeth         

Sadhan (DUC), Faleh  (MUC)

14

Guidelines for prescribing radiographs

Ekram (DUC,MUC)

 

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